Differences of Recovery from Rocuronium-induced Deep Paralysis in Response to Small Doses of Sugammadex between Elderly and Nonelderly Patients

• Published in: Anesthesiology (Philadelphia) 2018-11, Vol.129 (5), p.901-911
• Main Authors: Muramatsu, Takahiro, Isono, Shiroh, Ishikawa, Teruhiko, Nozaki-Taguchi, Natsuko, Okazaki, Junko, Kitamura, Yuji, Murakami, Noriko, Sato, Yasunori
• Format: Article
• Language: English
• Subjects: Accelerometry - statistics & numerical data; Aged; Anesthesia Recovery Period; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged; Neuromuscular Nondepolarizing Agents - pharmacology; Paralysis - chemically induced; Rocuronium - pharmacology; Sugammadex - pharmacology; Time Factors
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/ALN.0000000000002412

WHAT WE ALREADY KNOW ABOUT THIS TOPIC WHAT THIS ARTICLE TELLS US THAT IS NEW BACKGROUND:Complete recovery from rocuronium-induced muscle paralysis with sugammadex is reported to be delayed in elderly patients. The authors tested a hypothesis that recovery from deep neuromuscular block with low-dose sugammadex is slower (primary hypothesis) and incidence of recurarization is higher (secondary hypothesis) in elderly patients than in nonelderly patients. METHODS:In anesthetized elderly (n = 20; 76.9 ± 5.0 yr of age) and nonelderly patients (n = 20; 53.7 ± 12.8 yr of age) under deep paralysis with rocuronium, change of train-of-four ratio per minute (primary outcome variable) was measured with an acceleromyograph neuromuscular monitor during spontaneous recovery from rocuronium-induced muscle paralysis (0.6 mg/kg) and after infusion of low-dose sugammadex (50 µg · kg · min). Recurarization was defined as the negative change of train-of-four ratio. RESULTS:Spontaneous train-of-four ratio recovery rate was significantly slower in the elderly group (median [25th percentile, 75th percentile]1.89 [1.22, 2.90] %/min) than in the nonelderly group (3.45 [1.96, 4.25] %/min, P = 0.024). Train-of-four ratio change rate in response to low-dose sugammadex was significantly slower in elderly (0.55 [–0.29, 1.54] %/min) than in the nonelderly group (1.68 [0.73, 3.13] %/min, P = 0.024). Incidence of recurarization was significantly higher in the elderly group than in the nonelderly group (35% vs. 5%, P = 0.044). Multiple linear regression analyses indicate that slower spontaneous train-of-four ratio recovery rate and impaired renal function are two major contributing factors that decrease train-of-four ratio change rate in response to low-dose sugammadex. CONCLUSIONS:Elderly patients are at greater risk for recurarization and residual muscle paralysis when low-dose sugammadex is administered.